US20080235056A1

US20080235056A1 - Service for Managing Medications

Info

Publication number: US20080235056A1
Application number: US12/053,375
Authority: US
Inventors: Sol A. Gonzalvo
Original assignee: Individual
Current assignee: Individual
Priority date: 2007-03-23
Filing date: 2008-03-21
Publication date: 2008-09-25
Also published as: US20080235059A1; US20090012814A1

Abstract

A health management service includes a computerized management site having one or more servers executing software from coupled computer-readable media, and a data repository storing information regarding a plurality of enrolled persons, including at least medications and medication schedules for individual ones of the persons, and storing information regarding a plurality of associate or partner entities comprising at least physicians. In this service persons, in enrollment, enter personal data and medication data, the service stores the data in the repository associated with each enrolling person entering the data, associates the person with one or more physicians and other partner entities, whom also enter data in enrollment, and enables enrolled persons to share their individual medication data with associated physicians and other partner entities.

Description

CROSS-REFERENCE TO RELATED APPLICATIONS

The present invention claims priority to a provisional application 60/919,695 filed on Mar. 23, 2007, and to a second provisional application filed on Mar. 11, 2008, in the name of the present inventor, and the entire disclosure of the provisional applications are incorporated in their entirety at least by reference.

BACKGROUND OF THE INVENTION

1. Field of the Invention
This invention is in the broad field of internet-connected services, and pertains more particularly to a service for providing members with medication management.
2. Description of Related Art
It is well-known that millions of persons worldwide take one or medications regularly, typically prescribed by physicians, for managing medical conditions. Many people, especially older people, take multiple medications daily, and the particular regimen for a person that medicates may change regularly as well, as medical conditions get worse or better, and the prescribing doctors adjust medication levels, and change medications for the same medical conditions for their patients. It often happens as well that new conditions are discovered and diagnosed for patients, and new medications are added to the mix that a patient may regularly ingest.
Because of the wide-spread use of medications, and the frequent changes in dosage and medications for individual patients, keeping track of what medications and dosage is a frequent problem for individuals dependent on multiple medications. It is less well-known that there also may be many chemical reactions among different medications, creating chemical situations in a human body that may have completely unintended consequences. Another problem in this entire mix is related to the fact of increasing specialization in the medical field. It is often the case that one individual may be consulting one specialist for one condition, and another specialist for another condition, and the different specialists seldom have an opportunity to consult with one another.
Based on the above-described situation in general, what is clearly needed in the art is a service for medicated persons where all of the medications for a person may be listed and monitored, and which the person may depend upon for information about medications, combinations, expected side effects and the like, and where doctors prescribing medications for the person may also interact.

BRIEF SUMMARY OF THE INVENTION

The present inventor, being very familiar with procedures and processes in the field of medicine, interactions between persons needing medication, and physicians and hospitals providing medicinal services, has long been aware of many problems in that field. As a result the inventor has developed a service that can solve many of the problems.
In one embodiment of the present invention a health management service is provided, comprising a computerized management site having one or more servers executing software from coupled computer-readable media, and a data repository storing information regarding a plurality of enrolled persons, including at least medications and medication schedules for individual ones of the persons, and storing information regarding a plurality of associate or partner entities comprising at least physicians. Persons, in enrollment, enter personal data and medication data, the service stores the data in the repository associated with each enrolling person entering the data, associates the person with one or more physicians and other partner entities, whom also enter data in enrollment, and enables enrolled persons to share their individual medication data with associated physicians and other partner entities.
In various embodiments a variety of services are provided, such as:

- physicians associated with enrolled persons are enabled to edit and alter medications and medication schedules for individual enrolled persons with whom they are associated in the service, and alterations will be published by the service, subject to authorization by the enrolled person, with other physicians and associate and partner entities each also associated with the enrolled person.
- persons are enabled to enter allergies in general and allergies to medications, as well as medication data.
- in any transaction changing medication data for an enrolled person, allergy data is consulted, and participants are alerted to any potential problem.
- the data repository stores information regarding potential interactions between medications and between medications and common foods and beverages, and, in any transaction changing medication data for an enrolled person, the potential interaction data is consulted, and participants are alerted to any potential problem.
- new persons enrolling in the service, after entering their medication data, are informed of potential interactions between medications and potential effects of such interactions.
- enrolled persons are enabled to publish their medication data to third-parties, whether partner/associates of the service, or not.
- a mechanism is provided, including interactive interface, for a enrolled persons to purchase medications, products and services from enrolled partner firms.
- enrolled persons are afforded discounts for purchases from enrolled partner firms.
- the service provides email service to enrolled persons and partners and associates.
- enrollment provides membership requiring a periodic membership fee, and discounts on the membership fee are afforded to enrolled persons as reward for exceeding pre-set thresholds in purchasing medications, products and services from enrolled partner firms.
- the service seeks sources for medications, products and services from other than enrolled partners and associates.
- the service seeks sources for generic versions of medications.
- information regarding best times and circumstances for taking medications is stored, and provided to enrolled persons according to the enrolled person's medication data. And
- the service provides accounting and billing services for enrolled persons in the purchase of medications, products and services.

BRIEF DESCRIPTION OF THE SEVERAL VIEWS OF THE DRAWINGS

FIG. 1 is a diagram of elements of a service in an embodiment of the present invention.

FIG. 2 is a flow diagram depicting member sign-up for the service of FIG. 1.

FIG. 3 is a flow diagram illustrating how a member enters or modifies information in embodiments of the invention.

FIG. 4 is a flow diagram illustrating a method for a member may authorize a provider to send medications listings to any partner/associate or others in an embodiment of the invention.

FIG. 5 is a flow diagram that illustrates a method for providing purchase discounts to members in an embodiment of the invention.

FIG. 6 is a flow diagram that illustrates a method by which partner/associates may send members medical information in an embodiment of the invention.

FIG. 7 is a flow diagram that illustrates the use of electronic mail in an embodiment of the invention.

FIG. 8 is a flow diagram depicting free membership for a member if certain minimum purchase requirements are met within a defined period in embodiments of the invention.

FIG. 9 is a flow diagram that illustrates a process for members to authorize providers to enter medication purchases from other than partners/associates in embodiments of the invention.

FIG. 10 is a diagram that depicts a way for members to enter listings of medications from home or home medications into a provider site.

FIG. 11 is a flow diagram that illustrates the process of building up a medical history for a member in an embodiment of the invention.

FIG. 12 is a block diagram that illustrates a computer system upon which an embodiment of the present invention may be implemented.

FIG. 13 is a look-up flow diagram to find a name for “other medications” in an embodiment of the present invention.

FIG. 14 is a flow diagram that illustrates a method for informing a member as to when is the best time to take a medication.

FIG. 15 is a flow diagram that depicts a feature for automatically sending an email to other active physicians of the member if a new medication is prescribed.

FIG. 16 is a flow diagram that illustrates a process for listing of possible drug interactions between two or more medications if taken together at same time or same day.

FIG. 17 is a flow diagram that illustrates an audit for submitted third party medication billed charges.

FIG. 18 is a flow diagram that illustrates a method for secondary checking of medication billed charges submitted by any third party providers before final approval for payment is authorized.

FIG. 19 is a flow diagram that illustrates elements and mechanism of a MedTrackSystem in an embodiment of the invention.

FIG. 20 is a flow diagram that illustrates prescription medication inventory control for a wholly owned subsidiary according to one embodiment of the invention.

DETAILED DESCRIPTION OF THE INVENTION

FIG. 1 is a diagram of elements of a service 100 in an embodiment of the present invention. The service depicted is a system and method for providing members of the service an ability to enter information and print information from home of medications being taken, and to receive purchase discounts for medication purchases according to various embodiments described herein. As used herein, the term “enter and print” shall refer to entering of several categories of information for a member, such as medications that have been prescribed or may be prescribed by a licensed medical practitioner, over the counter medications, herbal supplements, member allergies, medical history, and some other personal information. The personal information may include but not be limited to addresses, telephone numbers of families, friends, business acquaintances or the like; into a provider's website 104, and printing the same off of provider's website.
As used herein, the term “purchase discounts” shall refer to any commercial goods or professional health care services that members may purchase from any partner/associate 106. As used herein, the term “medical history” refers to historical medical information about a member that may include but is not limited to diagnoses, procedures, medications taken, doctor visits, hospital visits, surgeries done, x-ray pictures taken and allergies, to name a few. Examples of such commercial goods include over-the-counter medications, health care supplies, health care equipment, prescription drugs or the like. An example of professional health care services include any health care practitioner services that may include physical therapies, respiratory therapies, laboratories, x-ray, MRI, CT Scan or the like, and the invention is not limited to any particular type of commercial goods nor health care practitioner's type.
According to one embodiment, a member 102 my enter over link 108 a listing of medications being taken from home, which may be simply termed “home meds”, and allergies which may be from food or medications or the like, which are stored associated with that member in a provider's member's database over link 108. Member 102 may be defined as a person without any affiliation to any particular group that may include, but is not limited to an insurance company or the like, whether a non-profit or for-profit, or a person who is affiliated with or a member of a group represented by an insurance company or the like, that could be classified as a non profit or a for-profit operation.
Link 108 may be of any medium for transferring data between member 102, providers 104 and/or partner/associates 106, and the invention is not limited to any particular medium. Examples of link 108 include, without limitation, a network such as a local area network (LAN), a wide-area network (WAN) or the Internet, a telecommunications link, a wire or optical link or a wireless connection. Partner/associates 106 may be centralized or distributed depending upon the requirements of a particular application, and may include but are not limited to, hospitals, doctors offices, licensed physicians, pharmacy stores, licensed therapeutic clinics, outpatient clinics, wholly owned subsidiaries, discount stores that sell prescribed or over the counter medications, insurance companies and employer's private or public to name a few.
In a situation where a member 102 gets admitted into a partner 106, being for example, a hospital, the hospital may be asking the member 102 the home meds listing needed for medication reconciliation, the purpose of which is for medication safety. For example, a treating physician is required to compare member 102 existing medications with medications that might be ordered during admission, transfer or discharge of member 102.
One of the ways in which member 102 may provide home meds listing to the partner/associate 106 would be via delivery channel 110. Delivery channel 110 may be implemented by any mechanism or medium that provides for the transfer of a copy of home meds listing from provider 104 database to partners/associates 106 and the invention is not limited to any particular type of delivery channel. Examples of delivery channel 110 include, without limitation, hand delivery by member 102, mail delivery, courier delivery, delivery using a delivery agent, or printing a copy over the internet to partner/associate 106 Internet printer.
Provider 104 in one embodiment is a single provider of the services alluded to in embodiments of the present invention, while member 102 and Partner/Associates 106 may be a varied plurality. That is, there may be many members of the service, that is clients of or subscribers to the service, and there may likewise be a broad variety of partners and associates according to the description above.
FIG. 2 is a flow diagram 200 illustrating how an individual member signs up for the service in one embodiment of the invention. Starting from step 202, in step 204, member 102 logs on to provider 104 web site. In step 206, member 102 signs up to become a member by agreeing to the terms and conditions set forth by provider 104. As used herein, the term “terms and conditions” refer to member 102 to pay a membership fee and provider 104 to provide the necessary secured database, delivery system, purchase discounts from partners/associates 106, and secure the member 102 information entered into provider 104 web-based computer system. In step 208, member 102 pays provider 104 a membership fee which could be a monthly, semi-annual or annual fee. As described previously, the purchase discount received by member 102 by purchasing commercial goods or professional services from partners/associates 106 may on an annual basis. In some situations, member 102 membership fee could be refunded if certain conditions are met. Member 102 may even receive purchase discounts whose total value may even exceed the annual membership fee resulting in a free membership. In particular, purchase discounts have no limitation as far as the purchase discount amount is concerned, and only are limited my member 102 purchases from partners/associates 106. In step 210, member 102 enters user's name, date of birth, email address and primary password, then in step 212, provider 104 sets up a secured database data record, that may include but is not limited to fields like name of member, date of birth, email address, name of medication, dose, route, frequency, date prescribed, name of doctor, date medication was started, date medication was stopped, reason for the medication, pictures of x-ray taken, or the like. At step 212 the service prepares and issues a membership card to the new member. The card may be called a “Medicard”. When either member 102 or any partner/associate wants to print member 102's “home meds”, the listing may be printed with the primary sort of active meds (active medications first, followed by stopped medications) then followed by the date when medication was prescribed, at least two names and telephone numbers of member 102 next of kin or authorized representatives, which could then be contacted in case of an emergency, and then the process is complete in step 214.
“Medicard” can be described as a printed membership card, being of a wallet size, having the provider 104 name and logo, the address, telephone number, the member 102 membership ID number, member address, telephone number and next of kin name and telephone number that may be printed at a front page, and the allergies and “home meds” may be printed at a back page of said “Medicard”.
FIG. 3 is a flow diagram 300 depicting a method by which a member a member enters or modifies allergies, “home meds” and other data. Starting from step 302, member 102 signs on to provider 104 web site using password 1 as shown in step 304. Then in step 306, member 102 opens up a Level I Database and enters the medications being taken from home “home meds”, allergies which may include but not limited to food allergies, medication allergies, substance allergies or any drug allergy interactions. Level I Database as shown in step 306 may be implemented by provider 104 by building database records that comprise fields that identify a specific member that may include without limitation, the name of the member, last four digits of social security number, date of birth, EMR (electronic medical record) number, telephone number, email address, sex, “home meds” listing, name/names of next of kin and their respective telephone numbers or the like.
As described previously herein, the listing of medications being taken from home or simply called “home meds”, in which corresponding database records need to be created by provider 104 in Level I Database may comprise field names that may include without limitation, name of doctor, the date medication was prescribed, name of medication, dose, route, frequency, reason for the medication, name of vendor, quantity, cost of each medication, date the medication was started, date the medication was stopped, and the like. In step 308, a determination is made whether the member 102 wants to modify existing records in Level I Database. If so, member 102 add/modifies entries in Level I Database. In step 310, member 102 enters new medications or modifies existing medication list being taken from home, allergies which may include but not limited to food allergies, medication allergies, substance allergies or any drug allergy interactions, then in step 312, the provider 104 verifies the accuracy of the medication entries entered by member 102, and makes necessary corrections if needed, and in step 316 a determination is made whether member 102 wants to enter or modify other data in Level II Database, in addition to “home meds” listing that may include without limitation, names, addresses, telephone numbers, anniversary dates, birth dates of relatives and friends, recipes or anything that might be of importance to a member 102 or the like. If not, the process is then complete in step 320.
If, however, member 102 decides to add other data to the Level II Database, then member 102 clicks on an icon specifically for Level II Database and enter member 102 password 2 in step 314. In step 316 member 102 enters/updates (Level II Database) and the process is then complete in step 320.
FIG. 4 is a flow diagram 400 showing a process by which a member 102 may authorize provider 104 to send a medication listing to any partner/associate, or whomever member 102 wants a list of allergies and “home meds” delivered to. After starting from step 402, in step 404 member 102 signs on by logging into a web site associated with provider 104, over link 108, which may be secured or unsecured depending upon the requirement of a particular application, by entering a user name and password 1. This process opens up the Level I Database specifically assigned to member 102 by provider 104, and in step 406, member 102 has options without limitation of printing member 102 allergies and “home meds” to his or her home printer, or print allergies and “home meds” to a partner/associate printer, or to any printer that member 102 so desires over link 108. The member may alternatively or also cause a file of the information to be delivered electronically to any connected party.
In step 408, a determination is made whether member 102 authorizes provider 104 to send member 102's allergies and “home meds” to any partner/associate. If not, then the process is complete in step 412. If, however, member 102 authorizes provider 104 to send the data to any partner/associate over link 108 or delivery channel 110, in which case step 410 is implemented, and then the process is complete in step 412.
FIG. 5 is a flow diagram 500 that illustrates a method for providing purchase discounts to member 102 for medication or other commercial products purchases from any partner/associate 106 as may have been agreed upon between partner/associate 106 and provider 104. After starting in step 502, in step 504, provider 104 issues a membership card to member 102. In step 506, member 102 may purchase the medication or other commercial products and may be entitled to purchase discounts that are based upon the previous agreements between partners/associates 106 and provider 104. Such purchase discount may range from 1 percent to any percentage that was agreed upon between the partners/associates and the provider. As an example, a 10 percent purchase discount will apply to all medication purchases and/or a 5 percent purchase discount to all other commercial products sold by any partner/associate 106. In step 508, a determination is made as whether the membership card is with the member 102 at time of purchase, and if the response is yes, then at step 512 the discount is implemented whereby the partner/associate 106 sells the products or services to member 102, deducting the agreed-upon purchase discount with provider 104, and the process is complete in step 514. However, if in step 508 member 102 does not have the membership card at the time of purchase, but the member 102 information is at partner/associate 106 database records, then step 510 is implemented, followed by step 512 in which the partner/associate sells the products deducting the agreed-upon purchase discount and the process is complete in step 514.
In a situation where customer 102 does not have the membership card at the time of purchase, and if in step 510 the member 102 membership information is not at the partner/associate 106 database base, then the process is complete in step 514 resulting of not being able to accommodate providing purchase discount to customer 102.
FIG. 6 is a flow diagram 600 that illustrates a method by which partner/associates 106 send member 102 medical information which may include, but is not limited to new medication prescriptions, new allergies, new drug reaction to certain medications or the like to provider 104 database over link 108 or delivery channel 110. After starting in step 602, at step 604 provider 104 updates the member 102 data records in Level I Database. In step 608 a determination is made as to whether member 102 is a new member, and if not, then provider 104 updates member 102 medical information that may include but is not limited to adding new medications, allergies, drug reactions or the like in step 612, and the process is then complete in step 614. If, however, member 102 is a new member, then step 606 is implemented, signing up the new member, and then in step 610 the new member 102 pays provider 104 the membership fee and the process is then complete in step 614.
FIG. 7 is a flow diagram 700 that illustrates use of electronic mail that may include without limitation the member 102, provider 104 and/or partners/associates 106. After starting in step 702, in step 704 a determination is made as to whether member 102 needs an electronic mail account, and if needed, then in step 706 provider 104 creates an electronic mail for member 102. Then in step 708 a determination is made as to whether member 102 needs an email reminder, which may include but is not limited to doctor's appointment, hospital visit, therapist visit, an anniversary date, a birth date or the like, and then in step 710 the provider 104 sets up automatic electronic reminders to be sent for those specified dates that have been requested by member 102, and the process is complete in step 712.
If, in a situation where a determination is made that member 102 in step 704 does not need an electronic mail account, then the control moves to step 708, where a determination is made as to whether member 102 needs an electronic mail reminder, which may include but is not limited to doctor's appointment, hospital visit, therapist visit, an anniversary date, a birth date or the like. Then in step 710 provider 104 sets up automatic electronic mail reminders to be sent for those specified dates that have been requested by member 102, and the process is complete in step 712.
If, however, after determining that member 102 does not need an automatic electronic mail reminder in step 708, then the process is complete in step 712.
FIG. 8 is a flow diagram 800 depicting free membership for a member if certain minimum purchase requirements are met within a defined “membership period”. As used herein, the term “membership period” refers, for example, to any twelve month period that begins at the first day of the member 102 signed up and ends at the last of day of the twelve month anniversary of signed up date. Other membership periods may pertain, however.
After starting in step 802, in step 804 a determination is made as to whether the member 102 has reached the minimum purchased amount for a membership period. The minimum purchased amount may include without limitation any amount of money that will be agreed upon by and between member 102 and provider 104. For example, one thousand dollars, five hundred dollars or any set amount that may be agreed upon by and between the member and the provider. If so, then in step 806, provider 104 tabulates all member 102 purchase discounts received from partners/associates 106. Then in step 808 another determination is made as to whether the annual membership fee paid by member 102 to provider 104 exceeds the member 102 total purchase discounts received for the membership period, and if it does, then it triggers step 810 where provider 104 refunds the excess membership over the total purchase discount for the year, and then the process is complete in step 812.
However, if in step 804, after determining that the member 102 did not reach the minimum volume amount for the year, then the process is complete in step 812. If however, if in step 808 after determining that the membership fee did not exceed the total purchase discounts received for the year, then the process is complete in step 812.
FIG. 9 is a flow diagram 900 that illustrates a process of member 102 authorizing provider 104 to enter medication purchases from other than partners/associates 106, which may be defined as “other medications”. After starting in step 902, in step 904, a determination is made as to whether member 102 wants provider 104 to enter and add “other medications” to provider 104 database, if so, then in step 906, member 102 sends the listing of “other medications” to provider 104. Then in step 908, the provider 104 enters the “other medications” to member 102 designated database, and in step 910, provider 104 sends a confirmation to member 102 either over the link 108 or the delivery channel 110, and the process is then complete in step 912.
If however, in step 904, after determining that member 102 does not want to send the listing of “other medications” to provider 104, then the process is complete in step 912. For purposes of calculating the member 102 purchase volume for the year as shown in step 804, the value of “other medications” does not qualify as a purchase and therefore cannot be added to member 102 total purchase volume for the year. “Other medications” are being added to member 102 list of medications at provider 104 database for the purpose of member 102 medication safety, and to continue building member 102 medical history. Specifically, a doctor at any partner hospital 106 or any doctor whether a partner/associate 106 or not, needs to know the present medications that member 102 is currently taking from home “home meds” so as not to have a possible complication with the introduction of newer medications that the attending doctor or other doctor will be prescribing to member 102. More specifically, certain drug combinations can be deadly and should be avoided at all costs.
FIG. 10 is a flow diagram 1000 that depicts a process whereby a set of members 1002 may enter their respective listing of medications from home or “home meds” into provider web site 1004. Member 1002 communicates with provider 1004 over links 1012, the global packet-switched network referred to as the “Internet” 1008 and a link 1010. Internet 1008 may be hard-wired or wirelessly connected. Links 1010 and 1012 may be any medium for transferring data between members 1002 and the Internet 1008, and between the Internet 1008 and the provider 1004, and between the Internet 1008 and partners/associates 1006, which may include a doctor, a hospital, a pharmacy or the like, and the invention is not limited to any particular medium. In the present example, links 1010 and 1012 may be connections provided by one or more Internet Service Providers (ISPs) and members 1002 and partners like doctors, hospitals, pharmacies 1006 or the like may be configured with generic internet web browsers. Links 1010 and 1012 may be secured or unsecured depending upon the requirements of a particular application.
In accordance with an embodiment, member 1002 signs up to become a member with provider 1004, and to enter the medications from home or “home meds” onto provider 1004 exclusive member-designated database, and to be afforded purchase discounts on medication purchases, health care professional services rendered or provided by any partner/associate 1006. For example, as previously described herein, “purchase discount” may apply without limitation to any commercial goods in addition to medication purchases from any partner pharmacy 1006, discounts on hospital charges from any partner hospital 1006, or discounts on professional health care services from any partner laboratory, radiology, physical therapy, home health providers 1006 or the like.
The invention is not limited to any particular approach for entering into membership agreement. For example, members 1002 and provider 1004 may enter into a membership agreement by mail, by telephone or over the internet, by members 1002 logging onto a web site associated with provider 1004 and using a graphical user interface (GUI). Members 1002 enter “home meds” listing unto provider 1004 designated member Level I database over links 1010 and 1012, and the Internet 1008 and using (GUI). Members 1002 may, as an option, send the listing of their respective medications from home or “home meds” to provider 1004 by mail, personal carriers, fax machines or the like. In turn, provider 1004 enters and adds the “home meds” into members 1002 designated Level I Database.
Members 1002 may, as another option, open up a secondary Level II Database by entering a secondary password onto provider 1004 web site over links 1010 and 1012 and the Internet 1008 and using GUI. In Level II database, members 1002 may enter without limitation, for example, addresses of family members, telephone numbers, anniversary dates, birthdates, recipes, bank accounts or the like. Members 1002 Level II Database records are confidential, and would only be editable and viewable by the member 1002 via entering the said secondary password. As described previously herein, Level I database can be accessed by any partner/associates 1006 if so authorized by member 1002, and that is for members 1002 medication safety in avoiding any accidental medication complications which may run the gamut from upset stomach to coma, or even death. Physicians have now recognized that some medications do not mix well with others. With the advent of ever-increasing array of prescription and over-the-counter medications and herbal supplements, the patients and doctors find themselves facing a growing problem of too many patients unwittingly taking dangerous combinations of drugs.
Members 1002 may also authorize, for example, a partner/doctor 1006 to send member 1002 a list of new medications or prescriptions to provider 1004 by delivery channel 1014, which may include but is not limited to the mail, telephone, personal carrier or the like. A partner/associate 1006 may also, by logging onto a web site associated with provider 1004 over links 1010 and 1012 and the internet 1008 and using a graphical user interface, transfer member 1002's list of medications or prescription over to provider 1004 Level I database. Other mediums for transferring member 1002 list of medications or prescriptions to provider 1004 may include, but is not limited to an FTP, an upload from partner/associate 1006 server to provider 1004 server.
Partner/associate 1006 is illustrated as a single entity for purposes of description only. Partner/associate 1006 may be centralized or distributed depending upon the requirements of a particular application. For example, a partner/pharmacy 1006 may operate in one location. Alternatively, a partner/pharmacy 1006 may be implemented by a network of locations that might even include locations located in another state or another country.
Partner/doctor 1006 in some situations may be able to communicate the new listing of medications of member 1002 to a partner/pharmacy 1006 by delivery channel 1014, which may include, but is not limited to encrypted e-mail, telephone, personal carrier, server-to-server link, a member delivering to any partner or the like. A partner/doctor 1006 may also, by logging onto a web site associated with provider 1004 over links 1010 and 1012 and the Internet 1008, and using a graphical user interface, transfer the list of medications or prescription over to partner/pharmacy 1006. Other mediums for transferring member 1002 list of medications or prescriptions from partner/doctor 1006 to partner/pharmacy 1006 may include, but is not limited to an FTP, an upload from partner/doctor 1006 server to partner/pharmacy 1006 server. For authentication purposes, member 1002 may be required to show some form of identification to partner/pharmacy 1006 before the delivery of medications to member 1002 is completed. Some form of identification may include without limitation an identification card that bears the picture of the member 1002 that may include for example, a valid driver's license, a membership card called “medicard” as previously described above, that is issued by provider 1004, a valid passport or the like. In other situations member 1002 may even send an authorized representative to pay for and receive the new medications from partner/pharmacy 1006.
According to one embodiment, purchase discount 1016 may be implemented for example, by an agreement between provider 1004 and partner/pharmacy 1006 by granting member 1002 certain purchase discounts 1016 on purchases of medications from partner/pharmacy 1006. Provider 1004 will deliver the list of eligible members 1002 to a partner/pharmacy 1006 by delivery channel 1014 which may include, but is not limited to encrypted e-mail, telephone, personal carrier, member delivering to any partner or the like.
Provider 1004 may also by logging onto a web site associated with provider 1004 over links 1010 and 1012 and the Internet 1008 and using a graphical user interface transfer the list of eligible members 1002 over to partner/pharmacy 1006. Other mediums for transferring active member 1002 listing from provider 1004 to partner/pharmacy 1006 may include, but is not limited to an FTP, an upload from provider 1004 server to partner/pharmacy 1006 server. In situations where a partner/pharmacy 1006 needs to verify for an eligibility for purchase discount 1016 of a member 1002, partner/pharmacy 1006 may have the option of using the delivery channel 1014, for example, for quick response a telephone call to provider 1004 will be sufficient, and for some that require non-urgent action, then another delivery channel 1014 like e-mail, personal carrier or the like will suffice.
The purchase discount 1016 may be in a form of a percentage of the selling price of the medication. Purchase discount 1016 may include, but is not limited to purchases of medications, prescriptions, or any other commercial products that a partner/associate 1006 might sell or services that may be provided by partner/associate 1006 to member 1002. An example of a purchase discount may include, but is not limited to a range of percentages like 1% to 90% of the selling price of medications or other commercial items, but may also apply to whole dollar discount like $5.00 for medication purchases totaling $50.00 to $75.00, or $10.00 purchase discount may be applied to perhaps equipment purchases that are valued between $75.00 to $100.00.
FIG. 11 is a flow diagram 1100 that illustrates a process of building up a medical history for member 1002. Medical history may include, but is not limited to compilation of all medical diagnoses, procedures done, allergies, medications taken previously, medications presently being taken, vaccinations, x-ray taken or the like. After starting from step 1102, in step 1104, member 1002 signs up onto the provider 1004 web site entering password 1 over links 1010 and 1012 and the Internet 1008, and using a graphical user interface to access member 1002 Level I database. In step 1106 member 1002 enters the names of an authorized partner/associate 1006 who could send member 1002 medical information to provider 1004. In step 1110, a determination is made whether partner/associate 1006 is authorized to auto-transfer member 1002 medical information directly into provider 1004 server over links 1010 and 1012 and the Internet 1008, and using the GUI, and if so, then in step 1112 the transfer of member 1002 medical information data is sent by member/associate 1006 to member 1002 Level I database at provider 1004 web site. If however, in step 1110, the member 1002 did not authorize the partner/associate 1006 auto transfer of medical information to provider 1004, then member 1002 becomes responsible in sending member 1002 medical information to provider 1004.
Member 1002 may have the option of using delivery channel 1014, which may include, but is not limited to an email, postal mail, personal carrier, member delivering to any partner or the like in sending the medical information to provider 1004, and then in step 1114 provider 1004 updates member 1002 Level I database, and the process of building/updating member 1002 medical history file is then complete in step 1116.
The approach described herein for a members to be able to enter lists of their medications being taken from home and receive purchase discounts on purchases of medications, services or any other commercial products and print, transfer their respective listing of medications, are particularly well suited for Internet-based membership system. The invention may be implemented in hardware circuitry, in computer software, or a combination of hardware circuitry and computer software and is not limited to a particular hardware or software implementation.
FIG. 12 is a block diagram that illustrates a computer system 1200 upon which an embodiment of the invention may be implemented. Computer system 1200 includes a bus 1218 or other communication mechanism for communicating information, and a processor 1220 coupled with bus 1218 for processing information. Computer system 1200 also includes a main memory 1212, which may include a random access memory (RAM) or any other dynamic storage device, coupled to bus 1218 for storing information and instructions to be executed by processor 1220. Main memory 1212 also may be used for storing temporary variables or other intermediate information during execution of instructions to be executed by processor 1220. Computer system 1200 further includes a read only memory (ROM) 1214 or other static storage device coupled to bus 1218 for storing static information and instructions for processor 1220. A storage device 1216, which may include a magnetic disk or optical disk, is provided and coupled to bus 1218 for storing information and instructions.
Computer system 1200 may be coupled via bus 1218 to a display 1202, such as a cathode ray tube (CRT), for displaying information to a computer user. An input device 1204, including alphanumeric and other keys, is coupled to bus 1218 for communicating information and command selections to processor 1220. Another type of user input device is cursor control 1206, such as a mouse, a trackball, or cursor direction keys for communicating direction information and command selections to processor 1220 and for controlling cursor movement on display 1202. This input device typically has two degrees of freedom in two axes, a first axis (e.g., x) and a second axis (e.g., y), that allows the device to specify positions in a plane.
The invention is related to the use of computer system 1200 for members to enter the list of their medications, allergies, personal information and be able to print, transfer such listing of medications, allergies, personal information and receive purchase discounts on purchases of medications or any other commercial products. According to one embodiment of the invention, the entering, printing, transferring of members' medications as well as the receiving of purchase discount, is provided by computer system 1200 in response to processor 1220 executing one or more sequence of one or more instructions contained in main memory 1212. Such instructions may be read into main memory 1212 from another computer-readable medium, such as storage device 1216. Execution of the sequence of instructions contained in main memory 1212 causes processor 1220 to perform the process steps described herein. One or more processors in a multi-processing arrangement may also be employed to execute the sequences of instructions contained in main memory 1212. In alternative embodiments, hard-wired circuitry may be used in place of or in combination with software instructions to implement the invention. Thus, embodiments of the invention are not limited to any specific combination of hardware circuitry and software.
The term “computer-readable medium” as used herein refers to any medium that participates in providing instructions to processor 1220 for execution. Such a medium may take many forms, including, but not limited to non-volatile media, volatile media, and transmission media. Non-volatile media includes, for example, optical or magnetic disks, such as storage device 1216. Volatile media includes dynamic memory, such as main memory 1212. Transmission media includes coaxial cables, copper wire and fiber optics, including the wires that comprise bus 1218. Transmission media can also take the form of acoustic or light waves, such as those generated during radio wave and infrared data communications.
Common forms of computer-readable media include, for example, a floppy disk, hard disk, a flexible drive, a flash drive, magnetic tape, or any other magnetic medium, a CD-ROM, any other optical medium, punch cards, paper tape, any other physical medium with patterns of holes, a RAM, a PROM, and EPROM, a FLASH-EPROM, any other memory chip or cartridge, a carrier wave as described hereinafter, or any other medium from which a computer can read.
Various forms of computer readable media may be involved in carrying one or more sequences of one or more instructions to processor 1220 for execution. For example, the instructions may initially be carried on a magnetic disk of a remote computer. The remote computer can load the instructions into its dynamic memory and send the instructions over a telephone line using a modem. A modem local to computer system 1200 can receive the data on the telephone line and use an infrared transmitter to convert the data to an infrared signal. An infrared detector coupled to bus 1218 can received the data carried in the infrared signal and place the data on bus 1218, from which processor 1220 retrieves and executes the instructions. The instruction received by main memory 1212 may optionally be stored on storage device 1216 either before or after execution by processor 1220.
Computer system 1200 also include a communication interface 1222 coupled to bus 1218. Communication interface 1222 provides a two-way data communication coupling to a network link 1138 that is connected to a local network 1236. For example, communication interface 1222 may be an integrated services digital network (ISDN) card or a modem to provide a data link communication connection to a corresponding type of telephone line. As another example, communication interface 1222 may be a local area network (LAN) card to provide a data communication connection to a compatible LAN. Wireless links may also be implemented. In any such implementation, communication interface 1222 sends and receives electrical, electromagnetic or optical signals that carry digital data streams representing various types of information.
Network link 1138 typically provides data communication through one or more networks to other data devices. For example, network link 1138 may provide a connection through local network 1236 to a host computer 1240 or to data equipment operated by an Internet Service Provider (ISP) 1234. ISP 1234 in turn provides data communication services through the world wide packet data communication network now commonly referred to as the “Internet” 1232. Local network 1236 and Internet 1232 both use electrical, electromagnetic or optical signals that carry digital data streams. The signal through the various networks and the signals on network link 1138 and through communication interface 1222, which carry the digital data to and from computer system 1200, are exemplary forms of carrier waves transporting the information.
Computer system 1200 can send messages and receive data, including program code through the networks, network link 1138 and communication interface 1222. In the Internet example a server 1230 might transmit a requested code for an application program through Internet 1232, ISP 1234, local network 1236 and communication interface 1222. In accordance with this invention, one such downloaded application provides for the member to enter the list of their medications as described herein.
The received code may be executed by processor 1220 as it is received, and/or stored in the storage device 1216, or other non-volatile storage for later execution. In this manner, the computer system 1200 may obtain application code in the form of a carrier wave.
FIG. 13 is a flow diagram depicting look up for other medication's name 1300. After starting from step 1302, in step 1304, member 102 or the partner/associate/physician 106 signs on to provider 104 web site. Then in step 1306, according to another embodiment, the member or the physician then enters the drug or medication name or some other naming convention that may include but not limited to the drug or medication mnemonic which can be formed as an alphabetic, alphanumeric or some other acceptable abbreviations that can be stored in a database. An example would be in a form of a “Drug Dictionary”. A drug dictionary can be defined as a listing of various medication fields that may contain but not limited to a drug mnemonic, a description, trade name, brand name, generic equivalent, side effects, purpose of medication, drug class, drug sub-class grouping, when is the best time to take this medication, the manufacturer, ingredients, drug type, control medication, restrictions, medication group names and/or any other relevant medication information. A medication group name field can be defined as a common field or two or more fields that will link one drug to another drug by way of an identifying code.
An identifying code for example, may be the first field of the drug dictionary which may contain a drug mnemonic that when selected a secondary selection may be provided with or without limitation, such as listing the other names of the drug. For example, when in use as shown in step 1308, when the member 102 or partner/associates 106 enters a mnemonic of “atoriota” the trade name “lipitor” along with the generic name of “atorvastatin” are displayed. On the other hand, when the member or partner/associate enter the trade name “lipitor” then the mnemonic of “atoriota” and generic name of “atorvastatin” are displayed or if the member or partner/associate enters the generic name of “atorvastatin”, then mnemonic of “atoriota” and trade name “lipitor” are displayed. By providing the member the necessary tool to question the doctor for possible drug duplication or for the doctor to avoid prescribing duplicate dedication of a drug by knowing exactly the drugs that the member 102 is currently taking will eliminate the chances of drug overdosing.
In addition to the above, when drugs lipitor and atorvastatin are prescribed at the same time to a member 102 further illustrates that overdosing can occur in incapacitation of member 102, which could have been prevented by adopting an effective warning protocol of MedTrackSystem and the process is then complete in step 1310.
FIG. 14 is a flow diagram 1400 that illustrates to member 102 as to when is the best time to take a medication. After starting in step 1402, in step 1404, the member 102 signs on to provider 104 web site. According to one embodiment, in step 1406, the member decides, selects and enter the medication mnemonic or name into the provider system (provider 104 patients database MedTrackSystem via the internet or link 108) that will provide the member the instructions as to when is the best time to take a specific medication. The best time to take a medication can be defined as taking the medication at its most potent time for the medication to be fully effective. For example, some medications may be more effective if taken before a meal or some would be more effective if taken after a meal or if taken with an empty stomach. In step 1410, a determination is made whether the member wishes to see the listing either by trade or generic names, then in step 1408, the member is given the option of selecting a field that could be either a trade or generic name and the member 102 in step 1412 is provided with the instructions as to when is the best time to take such medication selected thus the process is complete in step 1414.
If however, in step 1410, the member does not want to be provided a select field for either trade or generic, then step 1412 prints the instructions as to the best time to take such medication as selected in step 1406, and the process is complete in step 1414.
FIG. 15 is a flow diagram 1500 that illustrates a process for automatically sending an email to other active physicians of the member 102 if a new medication is prescribed. After starting in step 1502, in step 1504 the member visits a physician's office or a hospital. According to another embodiment, in step 1506, in situations where the member visits a physician's office and after a thorough medical examination of member 102, the physician decides to prescribe a new medication for the member, then in step 1508, the issuance of such new medication triggers an automatic sending of an email to all active members attending physicians along with the current listing of all active medications being taken by said member, and the member's medications database MedTrackSystem is updated. The prescription of new medication may be sent by the prescribing physician via delivery channel 110 which may include, but is not limited to an automated electronic prescription system to provider 104 wholly owned subsidiary medication depot, or to any partner/associate 106. The e-prescription system provided will incorporate and meets the requirements of HIPAA act of 1996 in regards to Security Standards for the Protection of Electronic Protected Health Information” which may include, but is not limited to privacy rule, electronic transaction and code sets rule, national identifier requirements for providers and health plans, security rule and other rules that might apply. For example, the e-prescription system will authenticate the prescription order by certain member 102 like the first plus last four digits of member 102 social security number and/or physician 106 first initial plus first four digits of last name, can be used as the combination code to authenticate each prescription order. This order will then be sent via secured multi-layered encryptions for additional security and protection which can be via an INTERNET 1008 or any other medium of transmission, in other situations where the member 102 gets admitted to a hospital either as an inpatient or as an outpatient. Upon member 102 discharge from said hospital, the member's medication database located at provider 104 MedTrackSystem is updated reflecting the addition of new medications. In step 1510, confirmations of receipts of auto-email for the issuance of new medication sent to active physicians are collected and noted, then the process is complete in step 1512.
FIG. 16 is a flow diagram 1600 that illustrates a process that provides a listing of possible drug interactions between two or more medications if taken together at same time or same day. After starting in step 1602, when a new prescription is issued to a member 102 by a physician 106 as shown in step 1604, and in step 1606, member 102 or physician 106, then signs on to provider 104 web site. In step 1608, once the member 102 or the physician 106 has signed on into provider 104 web site, the member or the physician has to enter the mnemonic or the name of the new medication that was just prescribed. The MedTrackSystem in step 1610, then automatically checks and prints the food and/or drug interactions of the new medication with that and all of the active medications that member 102 is currently taking. For example, if the new medication name is “lipitor” and one of the current active medication name is “clarithromycin” and with a “drug to drug” interaction the simultaneous taking of prescription drugs “lipitor and “clarithromcycin” may elevate the plasma concentrations of “HMG-CoA” reductase inhibitors that are metabolized by the isoenzyme resulting in the development of severe myopathy. As another example, the MedTrackSystem may provide member 102 and/or physician 104 food interaction of the new medication. Member 102 receiving therapy with “atorvastatin” or “lovastatin” should be advised to avoid the regular consumption of large amounts of grapefruits and grapefruit juice which could cause an unexplained muscle pain, tenderness or weakness. Provider 104 web site then returns the possible drug to drug or food to drug interactions that could be viewed on the computer screen, or prints them out to any attached printer and then the process is complete in step 1612.
FIG. 17, according to an embodiment, is a flow diagram 1700 that illustrates a process for an audit for submitted third party medication billed charges. Third party is defined as any professional service organization or organizations provider that may include, but is not limited to physicians, pharmacies, physical therapies, laboratories, radiologists, oncologists, psychiatrists, medical equipment suppliers or the like. After starting in step 1702, in step 1704, provider 104 MedTrackSystem analyzes the past and current member 102 diagnoses and/or procedures. A thorough analysis is performed by provider 104 to establish a base line protocol for each and every diagnoses or procedures that the member 102 had, the purpose of which is to make sure that all medical bills submitted by various third party providers are legitimate goods or services that are not only actually been delivered and services rendered but also necessary, and such submitted medication billed charges relate reasonably to one or more of the member 104 past or present diagnoses and/or procedures that had been done previously. For example, as a feature of MedTrackSystem, for each diagnosis that a member 102 had, a corresponding list that may include, but is not limited to the approved medications, supplies, equipment, or a list of professional services rendered and other related items are automatically listed for easy auditing. The same way is true for member 102 past or present procedures done, where the corresponding list that may include but limited to the approved medications, supplies, equipment or a list of professional services rendered and other related items are automatically listed for easy auditing. In step 1706, provider 104 examines the member 102 current diagnoses and/or procedures and compare with the prior diagnoses or procedures.
In continuing step 1708, as previously described herein, provider 104 applies the “reasonableness test” of MedTrackSystem to the medical billing charges submitted by any third party providers then in step 1714, a determination is made whether the medical billing charges submitted by third party providers meets “reasonableness test” relating to current or past diagnoses and/or procedures along with the approved required frequency, and if it does then in step 1722 the medical billing is submitted for secondary checking and the process is complete in step 1724.
If however, in step 1714, the submitted medical billed charges do not meet the required “reasonableness test”, then in step 1716, the first rejection of the submitted medical billing charges is sent back to the third party provider for additional information and upon resubmission of the medical bill charges for the second time, then the control returns to step 1708. Provider 104 then applies the second “reasonableness test” and in step 1714, a determination is made whether the re-submitted medical billing charges now meets the “reasonableness test”, and if it passes, then in step 1722, the bill is submitted for secondary checking and the process is complete in step 1724.
But if in step 1714, after a determination has been provided by provider 104 that the secondary medical bill re-submitted charges for the second time does not meet the reasonableness test”, then in step 1718 the medication billed charges is rejected for payment, then in step 1720, the third party provider is notified of the rejection and the process is then complete in step 1724. For example, a third party provider submitted a medical bill for a second a wheel chair, and after applying provider 104 “reasonableness test” the MedTrackSystem notifies the provider 104 that the submitted medical billed charges do not pass its “reasonableness test”, because another wheel chair has been paid to this third party provider a couple of months before. Upon examination by the MedTrackSystem, it points out that based on the diagnoses and/or procedures (passed and present) establishes that member 102 will only be needing another wheel chair in the next three to five years period. As another example, the MedTrackSystem could also have prevented the payment for another wheel chair, if the medical billed charges are submitted even without actual delivery of the second wheel chair to member 102, because MedTrackSystem checks for delivery of items before approval is authorized for payment.
FIG. 18 is a flow diagram 1800 that illustrates the method for secondary checking of medication billed charges submitted by any third party providers before final approval for payment is authorized. The MedTrackSystem classifies the member 102 submitted medication billed charges as either as an inpatient or outpatient medication billed charges. Inpatient medication billed charges is defined as billed charges incurred while a member 102 has been admitted to a hospital that lasted at least twenty four hours. Inpatient medication billed charges may include but not limited to hospital charges like room, laboratory, medication charges or the like, attending Doctors service fees or the like. Outpatient medication billed charges is defined as billed charges incurred by member 102, which may include, but is not limited to visiting a doctor's office for medical consultation or check up, physical therapies, medication purchases, laboratory visits, radiologic visits, medical equipment purchases, hospital visits where the member 102 check in the hospital and goes home same day and some other related charges.
According to another embodiment, after starting in step 1802, in step 1804, a determination is made as to whether member 102 visit is an inpatient or an outpatient, and if it is an inpatient, then in step 1808, the MedTrackSystem checks member 102 database for prior payments made that might relate to current billing being submitted for payment, and after thorough evaluation then another determination is made in step 1812, there the MedTrackSystem applies the reasonableness test by comparing the member 102 prior diagnoses and/or procedures, past or present in relation to the current billing submitted by any third party provider and if it passes the reasonableness test, then in step 1814, the bill is submitted for payment and in step 1816, the details of the medical bills that is being paid are entered into member 102 MedTrackSystem and the process is complete in step 1818.
For example, if member 102 had visited a hospital as an inpatient with a chief complain of “Appendicitis”, with an admitting diagnosis recorded of (541—Appendicitis Nos) that needed a surgical procedure done (47.01—Laparoscop Appendectomy) with a corresponding (CPT Code 44970—Laparoscopy, Appendectomy) will be the basis for reasonable medical charges billing. This medical charges billing may include incidentals like laboratory charges, room charges, medication charges or other reasonable charges that may seem to be appropriate. If, in step 1812, a determination is made that the medical bills submitted for payment does not meet the reasonableness test by MedTrackSystem, then the control returns to step 1810, where the submitted medical billed invoice is sent back to the third party provider and the process is complete in step 1818.
If however, in step 1804, after a determination is made that member 102 is not an inpatient, then in step 1806, a determination is made to determine whether a CPT code is associated with the description of each line of each item billed charges and if it meets the requirement, the control transfers to step 1808, the MedTrackSystem checks member 102 database for prior payments made that might relate to current billing being submitted for payment and after thorough evaluation then another determination is made in step 1812, where the MedTrackSystem applies the reasonableness test by comparing the member 102 prior diagnoses and/or procedures, past or present in relation to the current billing submitted by any third party provider and if it passes the reasonableness test, then in step 1814, the bill is submitted for payment and in step 1816, the details of the medical bills that are being paid are entered in member 102 MedTrackSystem database and the process is complete in step 1818. For example, if member 102 visits a doctor's office for an intolerable headache, and after the physician's medical diagnosis was done, it has been determined that primary diagnosis is (784.0—Headache). With this diagnosis of (784.0) a corresponding (CPT code 99282—Doctor visit) is generated. Any other medical bill charges submitted should be examined before authorizing payment.
If, in step 1812, a determination is made that the medical bills submitted for payment do not meet the reasonableness test by MedTrackSystem, then the control returns to step 1810, where the submitted medical billed invoice is sent back to the third party provider and the process is complete in step 1818. If, in step 1806, a determination is made to determine whether a CPT code is associated with the description of each line of each item billed charges and if it does not meet the requirements, then the control goes to step 1810 where the medical bills submitted charged invoice is returned to the third party providers and the process is complete in step 1818.
FIG. 19 is a flow diagram 1900 that illustrates the contents and mechanism of MedTrackSystem. The MedTrackSystem is defined as the automated searching tool that warns and checks for drug interaction of a new medication with that of all other active medications, provides the instructions as to when is the best time to take a medication for member 102 or any other authorized user. The MedTrackSystem is defined further as the tool that compiles listing and pairing of medication trade names with that of the its corresponding generic or brand names, collects and provide listing of allergies which could be a drug or a medication allergy, links CPT codes to paid medications, services, equipment and others, links CPT codes of paid medications, services, equipment purchases and others with that of member 102 diagnoses and/or procedures (past and present). The MedTrackSystem is further defined as “reasonableness test” in the examination of the details of submitted medical billing charges by any third party providers by following the established database guidelines developed by provider 104 which automatically lists all approved legitimate goods and/or services along with its reasonable frequencies that reasonably relates to a member 102 diagnosis or procedure past or present) or the combination thereof.
The MedTrackSystem is being further defined as a warning and checking mechanism that analyzes medication, dose, route, frequency and purpose. For example, the MedTrackSystem has a capability to forewarn member 102 or and partner/associate wholly-owned subsidiary 106 that the dose, route, frequency, and the like are not within a reasonable specification that has been established by the medication manufacturer, or other responsible authority. This process thus guides member 102, partner/associate wholly-owned subsidiary 106 or any other authorized user to enter the dose, route, frequency and the like correctly into provider 104 Level-1 Database using Password 1. Any entries that are not within the dose, route, frequency or the like guidelines will not be allowed to continue unless the entry or entries are corrected to within the guidelines, such as the manufacturer's established ranges. As an additional capability, member 102 or the wholly-owned subsidiary 106 would be able to double-check the dose, route, frequency and the like that has been provided by partner/associate physician or pharmacy 106. In situations where a conflict occurs between MedTrackSystem and the new medication that had just been prescribed, provider 104 will research the issue and find out the true dose, route, frequency and the like, and make the necessary corrections if needed. A friendly reminder is then sent to member 102, partner/associate wholly-owned subsidiary 106, as to the true and correct dose, route, frequency or the like for the newly-prescribed medication. The aforementioned MedTrackSystem is constantly being upgraded, corrected, adjusted and/or new items added or deleted as the need arises.
After starting in step 1902, in step 1904, provider 104 creates a member 102 database for paid medications, services rendered, equipment purchases or the like, along with their respective dates of payments, while in step 1906, the MedTrackSystem links the CPT codes to each and every paid medications, services, equipment or the like. In step 1908, MedTrackSystem also links the CPT codes of paid medications, services rendered, equipment purchases or others with member 102 respective diagnoses and/or procedures (past or present). This process is being done to assure that member 102 will only pay medical billed charges that are billed legitimately and without fraud, malice, erroneous billing, erroneous double billing or other non approved medical charges. In step 1910, MedTrackSystem establishes a guideline that will justify the reasonable relationships between the paid CPT codes with that of member 102 diagnosed and/or procedures (past or present). An established protocol is followed, for example, by a member 102, visiting a hospital or a doctor office for a fever check up. The front office staff entered an admitting diagnosis of (780.6—Fever). The examining physician had determined that member 102 will have a final diagnosis of (487.1—Flu with respiratory manifest nec). Accordingly, based upon the final diagnosis of 487.1, billing charges that are allowable without questions refer to (CPT code J1885—Ketoralac injection) and a (CPT code 99282—Emergency visit charge). Any laboratory charges, medicinal equipment charges will now be questioned before payments are authorized. MedTrackSystem will continue to update, change, add or delete items or process the protocol established for all diagnoses that have been identified and will be identified in the future.
Another important aspect of protecting member 102 against any fraudulent, erroneous, duplicated or any dubious medically billed charges presented for payment by any third party providers is shown in step 1912, where the MedTrackSystem determines the reasonable intervals of medication billings for same medication, same service, same equipment or the like. For example, supposing member 102 previously ordered twenty four (24) “lipitor” tablets which has already been paid previously, and a month later the same third party provider sends another medication billing charge for twenty four (24) “atorvastatin” tablets which is the generic name for “lipitor”. The “MedTrackSystem” then based on its logarithmic capability will determine that the reasonable interval and the shipment of same medication having two different names triggers an email to send member 102 and provider 104, as a reminder to double check this medication billing charges for accuracy and legitimacy, then the process is complete in step 1914.
FIG. 20 is a flow diagram 2000 that illustrates a process for prescription medication inventory control for a wholly owned subsidiary. The wholly owned subsidiary may be operated in the U.S.A or at any place in the world, or it can be centralized or distributed. In addition to providing member 102 the convenience of entering, adding, modifying, activating, deactivating medications and printing such home medication listing, can also authorized physicians, other authorized medical professionals or any other authorized users to view, print the listing of medications being taken from home by a member 102. Provider 104 may sell to member 102 any commercial products that may include but not limited to prescription medications, pharmaceutical supplies, over the counter medications, medical equipment and supplies or the like at wholesale price plus freight from any of the wholly owned subsidiary locations in the U.S.A. or any place in the world to any member 102 addresses that are located in U.S.A. or at any place in the world.
After starting in step 2002, in step 2004 a member 102 or a physician submits a new medication order for member 102. In step 2006, a determination is made whether the new medication order is in the database MedTrackSystem. If it is then in step 2010, a determination is made whether the new medication on order is the inventory. In this situation, if the new medication on order is in the inventory, then in step 2016, the medication is shipped from the wholly owned subsidiary location in the U.S.A. or at any place in the world to member 102 address in the U.S.A. or any place in the world, then member 102 database is updated with new medication shipped in step 2018. In step 2020, an email is sent to all active treating physicians notifying them that a new medication has been prescribed and delivered to member 102, and in step 2022, a courtesy notification of sending a list of all possible drug or food interactions, drug or food allergies of the new medication with the existing active medication of member 102 is sent to the member and/or all active physicians and the process is complete in step 2024.
If however, in step 2006, after a determination is made that the new medication is not listed in MedTrackSystem database, then in step 2008, the new medication is added to the database, in this case supplier is located in step 2012 then in step 2014, the medication is ordered. In this situation, upon receipt of new medication from the supplier, then in step 2016, the medication is shipped from the receiving wholly owned subsidiary location in the U.S.A. or at any place in the world to member 102 address in the U.S.A. or any place in the world, then member 102 database is updated with new medication shipped in step 2018. In step 2020, an email is sent to all active treating physicians notifying them that a new medication has been prescribed and delivered to member 102, and in step 2022, a courtesy notification of sending a list of all possible drug or food interactions, drug or food allergies of the new medication with the existing active medication of member 102 is sent to the member and/or all active physicians and the process is complete in step 2024.
If, in step 2010, after a determination is made that the new medication being ordered is not in the inventory, then medication is ordered in step 2014, and in this situation, upon receipt of new medication from the supplier, then in step 2016, the medication is then shipped from the receiving wholly owned subsidiary location in the U.S.A. or at any place in the world to member 102 address in the U.S.A. or any place in the world, then member 102 database is updated with new medication shipped in step 2018. In step 2020, an email is sent to all active treating physicians notifying them that a new medication has been prescribed and delivered to member 102, and in step 2022, a courtesy notification of sending a list of all possible drug or food interactions, drug or food allergies of the new medication with the existing active medication of member 102 is sent to the member and/or all active physicians and the process is complete in step 2024.
The novel approached described herein for the members to be able to enter the list of their medications that are currently being taken from home and having the options of adding, modifying, retrieving, transferring or printing such medications listing stored at Level I Database provides several advantages over remembering such medications from memory. Partners like Doctors' would be able to update Members medication listings by either entering the new medications directly to Provider's website, or sending the list of said medications to the Provider via various delivery channels as previously described herein, in which Provider updates members medication listing or the Member signing on to provider website and update their respective medications listing. For example, if a Member enters a Hospital, it is now mandatory for a prospective patient to provide a list of current medications that said patient are taking from home.
More specifically, an attending Physician needs to know the medications a patient is currently taking from home before prescribing a new one to make sure that there would be no medication interactions among the medications the patient are currently taking with that of the new ones that are about to be prescribed. Medication interactions which are sometimes referred to as “adverse drug events” have been documented to have resulted in some cases contributed into worsening of the patient conditions and in some events have resulted in death. Furthermore, the subscribing members are afforded with purchase discounts for medication purchases from any partner/associates. This said purchase discounts may also apply to other commercial products or professional services that may be available from time to time at any participating partner/associates. Membership fees may be waived on some members who have met the minimum dollar volume requirements within a membership period. Furthermore, members are provided a secondary storage (Level II database) in which other personal information can be stored safely, that may include but not limited to telephone numbers, birthdates, anniversary dates, addresses, secret recipes or the like, and only accessible by Members through the use of a secondary password.
In the forgoing specification, the invention has given the members the ability to enter, add, modify, activate, deactivate medications and printing such home medication listing, can authorize physicians, other authorized medical professionals or any other authorized users to view, print the listing of medications being taken from home by a member, authorize physicians or other authorized medical professionals. Provider may sell to member any commercial products that may include but not limited to prescription medications, pharmaceutical supplies, over the counter medications, medical equipment and supplies or the like at wholesale price plus freight from any of the wholly owned subsidiary locations in the U.S.A. or any place in the world and ship such commercial products or the like to any member addresses that are located in U.S.A. or at any place in the world.
The development of MedTrackSystem provides the look ups, printing of trade, brand or generic names of prescription medications minimizes the error of prescribing duplicated medications the reason that some medications have multiple names assigned to them. The capability of the MedTrackSystem in providing members the instructions as to when is the best time to take each prescribed medication to take advantage of the full potency of the said medication if taken properly, the auto sending of email to all other active physicians that a new medication has been prescribed so a heart specialists would know if the family physician has prescribed a new medication that may harm the member heart's condition. Additionally, MedTrackSystem provides listing of possible drug interactions or food interactions when a new medication is prescribed that could have produced a dangerous side effects of new medication in relation with those that are still active medications that the members are simultaneously taking, the introduction of medication audit to protect members against fraud, erroneous billing, duplicate billings by utilizing the past and present diagnoses and/or procedures. The ability of MedTrackSystem to provide a secondary medication billed charges checking by classifying member visits either inpatient or outpatient, and full utilization of using CPT Codes, Diagnosis code and Procedure codes to link reasonably all medication billing charges before payment is authorized, the development of MedTrackSystem where logarithmic logical sequencing are used to establish different a reasonable protocols that may apply to CPT codes, Diagnosis codes and Procedure codes, and providing members low cost of prescription medications, pharmaceutical supplies, over the counter medications, medical equipment and supplies or the like at wholesale price plus freight from any of the wholly owned subsidiary locations in the U.S.A. or any place in the world and ship them to any member addresses that are located in U.S.A. or at any place in the world.
In the foregoing specification, the invention has been described as applicable to an implementation anticipating Internet based processing which may include entries and retrievals of the subscribing members listing of their respective medications from home and in time builds medical history. Additionally, this invention provides the members special advantages of not only having a safety assurances against adverse drug events but also reduce their lifetime medication cost.
In the foregoing specification, the invention has been described with reference to specific embodiments thereof. However, various modifications and changes may be made thereto without departing from the broader spirit and scope of the invention. The specification and drawings are, accordingly, to be regarded in an illustrative sense rather than a restrictive sense, and the scope of the invention is limited only by the claims that follow.

Claims

1. A health management service, comprising:

a computerized management site having one or more servers executing software from coupled computer-readable media; and

a data repository storing information regarding a plurality of enrolled persons, including at least medications and medication schedules for individual ones of the persons, and storing information regarding a plurality of associate or partner entities comprising at least physicians;

wherein persons, in enrollment, enter personal data and medication data, the service stores the data in the repository associated with each enrolling person entering the data, associates the person with one or more physicians and other partner entities, whom also enter data in enrollment, and enables enrolled persons to share their individual medication data with associated physicians and other partner entities.

2. The service of claim 1 wherein the computerized management site is Internet-connected, and persons and associate and partner entities interact with the service through Internet connection.

3. The service of claim 1 wherein physicians associated with enrolled persons are enabled to edit and alter medications and medication schedules for individual enrolled persons with whom they are associated in the service, and alterations will be published by the service, subject to authorization by the enrolled person, with other physicians and associate and partner entities each also associated with the enrolled person.

4. The service of claim 3 wherein the person is enabled to enter allergies in general and allergies to medications, as well as medication data.

5. The service of claim 4 wherein, in any transaction changing medication data for an enrolled person, allergy data is consulted, and participants are alerted to any potential problem.

6. The service of claim 3 wherein the data repository stores information regarding potential interactions between medications and between medications and common foods and beverages, and, in any transaction changing medication data for an enrolled person, the potential interaction data is consulted, and participants are alerted to any potential problem.

7. The service of claim 6 wherein new persons enrolling in the service, after entering their medication data, are informed of potential interactions between medications and potential effects of such interactions.

8. The service of claim 1 wherein enrolled persons are enabled to publish their medication data to third-parties, whether partner/associates of the service, or not.

9. The service of claim 1 further comprising a mechanism, including interactive interface, for a enrolled persons to purchase medications, products and services from enrolled partner firms.

10. The service of claim 9 wherein enrolled persons are afforded discounts for purchases from enrolled partner firms.

11. The service of claim 1 wherein the service provides email service to enrolled persons and partners and associates.

12. The service of claim 9 wherein enrollment provides membership requiring a periodic membership fee, and discounts on the membership fee are afforded to enrolled persons as reward for exceeding pre-set thresholds in purchasing medications, products and services from enrolled partner firms.

13. The service of claim 1 wherein the service seeks sources for medications, products and services from other than enrolled partners and associates.

14. The service of claim 13 wherein the service seeks sources for generic versions of medications.

15. The service of claim 1 wherein information regarding best times and circumstances for taking medications is stored, and provided to enrolled persons according to the enrolled person's medication data.

16. The service of claim 9 wherein the service provides accounting and billing services for enrolled persons in the purchase of medications, products and services.